27 Anemia and TransfusionAnemia predicts adverse outcomesCurrent transfusion practice provides no benefit or is harmfulIschemic complications were not decreased with blood transfusionMurphy et al. 2007Patients who received blood that was stored for more than 2 weeks prior to transfusion had a statistically significant increase in in-hospital mortality, prolonged intubation, renal failure and sepsis or septicemiaKoch 2007

34 Efficacy of RBC Transfusion in the Critically IllRBC transfusion did not improve VO2RBC transfusion was not associated with improvements in clinical outcomesRBC transfusion was associated with worse outcomesFactors to identify patients who may benefitLack of efficacy related toAdherence of stored RBCsNitric Oxide bindingDonor leukocytesInflammatory responseDecreased red cell deformability

43 DDAVP Dose: 0.3 mcg/kg over ½ hour Release of factor VIII and vWFEnhances platelet adhesion to the vessel wallShortens the prolonged aPTT and bleeding time

44 Conclusion Benefits of transfusion are theoreticalRisks of transfusion are factTransfusion of allogeneic blood represents a major risk for immunosuppression and adverse outcomeTransfusion must be considered carefullyAccept lower transfusion thresholdsAlternatives to RBC transfusion